Outcomes in patients ≥80 years with a diagnosis of a hepatopancreaticobiliary (HPB) malignancy

A. R. Lewis, C Cipriano , X Wang, R Ward, A Fitzpatrick, A R M Scott, A Rashed, H Raja, A Lamarca, R A Hubner, Juan Valle, Mairead Mcnamara

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Abstract

Introduction: Older patients are underrepresented in oncological clinical trials. The incidence of hepatopancreaticobiliary (HPB) malignancies is higher in older patients, but data on outcomes is lacking. Objectives: This study assessed patient outcomes in those <80 and ≥80 years with a HPB malignancy seen at a tertiary referral centre, The Christie NHS Foundation Trust. Methods: Data on patients with a HPB malignancy were collected retrospectively between 2012 and 2017 via on-line case-note review. Survival was calculated using the Kaplan-Meier method and prognostic factors using log rank analysis. Results: Of 1421 patients, 10% were ≥80 years. Of patients <80 and ≥80 years, 56% and 57% had pancreas cancer, 39% and 36% biliary tract cancer, and 5% and 7% had hepatocellular carcinoma respectively. Amongst patients ≥80 years, 75% had an Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2. Patients ≥80 years had higher rates of co-morbidity; 28% received systemic anti-cancer therapy (SACT), compared with 62% of patients <80 years. Best supportive care (BSC) was instituted in 44% of older patients, compared with 13% in those <80 years. Of patients ≥80 years who received SACT, 82% received monotherapy. Median overall survival (OS) for patients receiving palliative SACT was 10.07 months (95% CI 8.89-11.08) and 10.10 months (95% CI 6.30-12.30) in patients <80 and ≥80 years, respectively, p 0.41; ECOG PS (p<0.001) was prognostic for OS in older patients but Adult Comorbidity Evaluation-27 co-morbidity score (p=0.07, when comparing groups of ACE score <=1 and >1) was not. Conclusions: Baseline factors were similar in both age cohorts, but more co-morbidities were present in older patients. Older patients were less likely to receive SACT, but when they did, they had an equivalent benefit in OS to younger patients.
Original languageEnglish
JournalMedical Oncology
Early online date6 Sept 2019
DOIs
Publication statusPublished - 2019

Keywords

  • elderly oncology
  • geriatric
  • hepatobiliary
  • cancer

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre

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